Just what the hell “is” going on during the menopausal period in your life?
This is a question I receive often from frustrated ladies who are experiencing their bodies going haywire on them. And just what the hell is going on here?
There are many common elements of metabolic and hormonal scenarios that I will discuss below. The fact is that what many ladies over 40 refer to as “metabolic damage from dieting” is actually something else. Make no mistake: the metabolic changes are very real, and the hormonal changes and obstruction are very real as well. It is just that during the pre- and peri-menopausal phase of life these changes are often more due to “transition” than to metabolic damage and weight-gain due to dieting.
Metabolism and hormones go together and affect each other in very pronounced ways. In the menopausal era of a woman’s life this can wreak havoc on what used to feel like “normal function,” and it can be a nightmare for trying to control weight.
Solutions begin with a clear understanding of the problem. During menopause, the issues begin hormonally. The estrogen/progesterone balance changes are the first of the issues I think worth understanding here.
The Estrogen Dominance Phase
Here is the usual hormonal cascade: both estrogen and progesterone levels decline with age, but progesterone goes first and at a much steeper slope. A menopausal woman has 5% of the progesterone she had in her 20s, yet she still has about 40% of her estrogen, just because of the way estrogen is stored in fat cells. Those fat cells continue to pump out estrogen throughout her life—note that this means “estrogen dominance” is a bigger problem if you are overweight, and an even BIGGER problem if you are overweight from Yo-Yo dieting. This becomes a very cruel negative feedback loop: estrogen promotes fat storage and weight gain, and these fat cells in turn trigger the production of more estrogen. With the metabolic dysregulation caused by yo-yo dieting, these hormonal effects are even more pronounced.
Of course, in the modern world we live in, you must also consider environmental “xenoestrogens” as well. They too get stored in fat cells, and add to the cyclic effects of estrogen making fat, with the fat in turn making estrogen.
This unopposed estrogen brings more problems with it when you don’t ovulate. As Julie Holland points out in her book Moody Bitches, “Unopposed estrogen is not just uncomfortable, it’s dangerous, putting you at risk for uterine, ovarian, breast and colon cancer” (p. 121).
There is also a good change you are going to “feel” fatter because unopposed estrogen without ovulation means more water retention and bloating. These often get confused as nutritional issues, even though they are not.
The Thyroid Connection and Depression
Furthermore, these high estrogen levels signal the liver to make a protein called “thyroid-binding-globulin.” This drastically lowers your free thyroid hormone, which helps keep metabolism robust and healthy. This is accompanied by feelings of sluggishness, mentally fog, feeling cold all the time, especially in the extremities, feeling as though your skin is dry, and your weight won’t budge even though “it should” based on what you are eating.
If this scenario sounds all too familiar to yoy, I recommend getting blood work done; specifically looking at TSH and free thyroid hormone levels. List your symptoms to your doctor, and she/he will know what to screen for.
The statistics here are that hypothyroid issues are fifteen times more likely in women than in males. This is especially the case in the pre- and peri-menopausal stages of life. For instance, 50+ yrs. old women produce half the thyroid hormones than their 20-year-old counterparts. Depression is also a common co-effect reported by ladies with hypothyroid issues. Symptoms here include problems concentrating (again, mental fog), low sex drive, low energy, and just low moods, overall apathy and loss of vitality. So all this is a long way of saying, before you go on anti-depressants, you may want to get your thyroid checked, and rechecked as well.
The Next Stage: Another Hormonal Swing
Now, as many of you have lived through, or are living through right now, in the second stage, that is, the peri-menopausal transition, your ovaries finally tap out and your estrogen levels plunge.
“Estrogen dominance” is gone, but now you have new symptoms caused by the sudden low estrogen. Topping the list of these symptoms are moodiness, irritability and mood swings on the emotional side of the equation, and hot flashes, night sweats, and low libido and sex drive on the physical side. (These are the most common, although there are more)
The risk of depression practically triples in the peri-menopausal transition phase. Research clearly shows the prevalence of depression is highest in women aged 40-49, and yet it is lowest of all in women over 60. This is often referred to as “the storm before the calm” (see Holland’s book).
In my coaching, each and every year I have dozens of ladies who write me who are in this age group and they make statements to me like “I have everything. I should be happy. Why am I not happy?” Many of them come to me thinking they can diet their way out of this scenario. Diet and training may have “some effect,” to be sure. But during this storm before the calm, the effects of diet and training are more like adding an umbrella to weather the storm; yet they don’t just bring better weather all on their own.
The Cortisol Connection
As estrogen levels fall dramatically during this phase, your metabolism becomes more sensitive to cortisol-stimulated fat accumulation. This means that the more physical and mental “stress” you have in your life, the more likely you are to partition food toward more fat storage. Stress, therefore, is something to keep an eye on.
Here’s the other thing: In this phase, your appetite for food goes up as well. It’s a biochemical and hormonal effect, but it is real nonetheless. So in these pre and peri menopausal phases you can experience a very negative one-two punch of a slow and sluggish metabolism on the one hand, combined with a new increased and often ravenous appetite on the other.
Research shows that rats that have had their ovaries removed—to mimic menopause—have an increased desire to eat and drink. That increased hunger you felt if you experienced PMS when you were younger? Well it’s like that, but instead of only being there for a couple of days, it’s constant.
Furthermore, these rats show increased anxiousness and depressive behaviors as well. Yet all of this is all normalized when the rats are given supplemental estrogen. Again, this clearly demonstrates the connection between estrogen balance and emotional health and well-being. In terms of weight and metabolism, HRT (hormone replacement therapy) can be self-saving and health-promoting. It can also be a helpful means to normalizing weight and appetite, by setting metabolic and hormonal processes in order, and back ‘online’ so to speak.
The “Pausal-Pounds Problem”
Research shows that women between the ages of 35-45 gain weight faster than at any other time in their lives, on average. I know this to be true even in my own observations of the demographic of letters I get each week, from those ladies who desperately want to figure out their “Pausal-Pounds Problem.”
By their late 40s, a majority of women who have little to no exercise background are overweight or obese. One of the biggest reasons for this is not “laziness.” Rather, the caloric or energy requirement of ladies in this age demographic is 65% less than their energy needs when they were in their 20s. This down-regulation in metabolism doesn’t tend to happen gradually, either. It’s pretty sudden and abrupt. Yet, appetite and hunger do not slow down at the same pace as the decreased energy needs do. If even more hunger is induced by trying to survive deprivation dieting, the likelihood of regaining that weight as fat increases.
If you don’t learn before this point in life to handle food, you’ll find that food is now likely handling you. This is where many of those “friends you know and envied”—the ones who could eat whatever they wanted in their 20s and not gain weight—they are now the ones paying a “heavy” price for not learning to regulate hunger and appetite in healthy ways in their younger years. Many who are caught in this vortex simply have to learn how to eat all over again.
Note that this doesn’t mean “learning to eat” by counting each and ever calorie and controlling macros and all the rest. This is the “outside-in” approach. Instead, it means learning how to gauge your own biofeedback, and feeding your metabolism to optimize it. You learn to listen to your body. You eat whole foods. You keep track of stress. You get good sleep. It is all connected.
Now, a word on soy products is warranted here: soy and soy milk have components that bind to estrogen receptors, but they do not create “a spike” in estrogen levels per se. However, this can lengthen the “luteal phase” of your cycle and cause heavier menstrual bleeding. But if you expect you are “estrogen dominant” – for instance you have heavy periods and cramping – then avoiding soy products is good sense.
Post-menopausal women who take estrogen are half as likely to develop Alzheimer’s as those who do not. Estrogen replacement therapy in the menopausal years may in fact stall or prevent dementia. As you get older, there are many reasons to look into hormonal replacement therapy to balance hormones and metabolism. New approaches actually also include very low levels of testosterone administration as well; this approach also looks very promising. Let me say, though, I am not a fan of “bioidentical hormones.” I firmly believe actual medical intervention is the way to go if menopause is a real problem for you to manage.
Clearly, menopause is a period in life that can lead to many negative unwanted changes such as depression and weight-gain, and these two things can feed off each other. Many of these issues get attributed to the wrong causes, which means the wrong treatment gets attempted as well. It can all be very confusing. But it doesn’t have to be that way. Proper exercise, good food, proper habits (generally, you know what they are), and if necessary medical intervention—not supplementation—can go a long way towards a smooth transition through this period.
References
Asarian, L, and N Geary. “Modulation of Appetite by Gonadal Steroid Hormones.” Philosophical Transactions of the Royal Society B: Biological Sciences 361.1471 (2006): 1251–1263. Web. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1642706/.
Corio, Laura The Change Before the Change: Everything You Need to Know to Stay Healthy in the Decade Before Menopause, New York: Bantam, 2000.
Freeman, Ellen W et al. “Hormones and Menopausal Status as Predictors of Depression in Womenin Transition to Menopause.” Archives of General Psychiatry 61.1 (2004): 62. Web. http://archpsyc.jamanetwork.com/article.aspx?articleid=481940
Holland, Julie M.D. Moody Bitches: The Truth About the Drugs You're Taking, The Sleep You're Missing, The Sex You're Not Having, and What's Really Making You Crazy. New York: Penguin Press, 2015.
LeBlanc, Erin S et al. “Hormone Replacement Therapy and Cognition.” JAMA: The Tournal of the American Medical Association 285.11 (2001): 1489–1499. Web. http://jama.jamanetwork.com/article.aspx?articleID=193670
Northrup, Christiane The Wisdom of Menopause: Creating Physical and Emotional Health During the Change. New York: Random House, 2012.
Amin, Z. “Effect of Estrogen-Serotonin Interactions on Mood and Cognition.” Behavioral and Cognitive Neuroscience Reviews 4.1 (2005): 43–58. Web. http://bcn.sagepub.com/content/4/1/43.full.pdf